A Dunedin professor warns that a "serious conversation" is needed over a lack of funds to support life-saving cancer tests at the country’s only dedicated oral pathology dental service.
“Poor dental health can have devastating impacts on people’s lives, and the lack of an oral pathology service would quite simply result in unnecessary death," Prof Mike Morgan says.
"I believe it is time New Zealand has a serious conversation about these funding anomalies,” Prof Morgan, the University of Otago Faculty of Dentistry dean, says.
Every year throughout the country, more than 3000 tissue samples are taken by dental professionals when abnormalities in a patient’s mouth are encountered and require further investigation.
Often, the results indicate life-threatening conditions, including cancers and other diseases.
However, because of an unintended legislation mix-up in the 1990s, pathology laboratories are not funded from the country’s health budget for the testing of specimens taken by dentists and dental specialists.
Instead, the Otago University’s Oral Pathology Diagnostic Service has taken on much of this task and picked up the tab for oral pathology testing.
Over the years, the university had asked for the funding anomaly to be addressed, but without success.
Now, because of the financial constraints caused by Covid-19, the university’s ability to absorb the lab’s costs was becoming untenable, Prof Morgan said.
The tests average about $300 each, with the service’s annual cost totalling about $1 million.
The service is one of the only aspects of dentistry that directly saves lives, Prof Morgan says, and many of the conditions picked up by the testing become far more dangerous and more difficult to treat the longer they are left.
Otago University says it is not threatening to cut the service – doing so could cost dozens of lives every year in New Zealand and interrupt teaching and research in the Faculty – but paying for it in future will mean that other core university functions will have to be sacrificed.
Otago Oral Pathology Centre head Prof Alison Rich says a small administration fee is charged back to some of the professionals ordering the test – a cost passed on to patients.
However, increasing the fee could have fatal consequences by causing the clinician or the patient to hesitate and not take a biopsy.
“It comes back to this ongoing issue of dentistry funding in New Zealand," Prof Rich said.
"Because of the high existing costs to patients, we already have substantial segments of our population effectively priced out of dental care.
"They just don’t go to the dentist. If people who are only just able to scrape together a dentist’s fee then get told they’ll need to stump up another $300 for a test, many are likely to say no to the test.
"And lives will be lost," Prof Rich warned.
Oral cancer has a death rate which is at least as high as that seen with cancers such as melanoma and breast cancer.
Most oral cancer cases are picked up late because the people who are most at risk are also those who are least likely to be seen by dentists for regular check-ups.
This makes timely and efficient diagnosis and treatment crucial for their survival.
Prof Morgan says it is core university funding which will effectively pay for this service if another solution is not found.
“The reality is the University is in large-part funded by students.
"And it’s them, essentially, who are going to fund this oral pathology service for the people of New Zealand.
"I suspect that won’t seem right to most New Zealanders, and it certainly doesn’t seem right to me.”